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An order form from Schiller Bros. Distilling Co. of Kansas City, MO. The form measures approximately 5-1/2" x 8-1/2" and is undated, although the name usage on the accompanying cover letter suggests 1916 or later.

The obverse provides areas to enter name and shipping information.

The form and associated material was generously donated by Sharon Lusk of Albuquerque, NM.